Radiotherapy For Breast Cancer Research Articles

95 Volumetric Modulated ARC Therapy for Delivering 26GY in Five Fractions Using the Fast-Forward Protocol in Ultra-Hypofractionated Whole Breast Radiation Therapy for Breast Cancer

95 Volumetric Modulated ARC Therapy for Delivering 26GY in Five Fractions Using the Fast-Forward Protocol in Ultra-Hypofractionated Whole Breast Radiation Therapy for Breast Cancer

41P Cancer therapy-related cardiac dysfunction (CTRCD) after radiation therapy for breast cancer: Results of the French BACCARAT study

41P Cancer therapy-related cardiac dysfunction (CTRCD) after radiation therapy for breast cancer: Results of the French BACCARAT study

Coping with modesty during radiotherapy for breast cancer: a multicentric study.

Breast cancer is the most frequently diagnosed tumour, representing nearly 30% of all new cases in women. Radiotherapy (RT) plays a crucial role in the management of breast cancer. The objective of this study is to assess modesty in patients undergoing RT for breast cancer and take their suggestions and ideas into consideration to enhance the quality of treatment in this regard. The study enrolled 555 breast cancer patients undergoing adjuvant RT in three Italian centres. Patients completed a self-test questionnaire assessing their comfort level concerning modesty during therapy and their relationship with strangers and healthcare professionals. The impact of religious views and potential changes in sexuality were also examined. Results showed that modesty was a common concern across the overall cohort of patients, with discomfort in being undressed during RT correlating with discomfort experienced in other daily life situations. Most patients felt more at ease with same sex healthcare workers. Age was also a major factor with younger patients generally feeling more comfortable with healthcare workers of the same age group. Interestingly, the surgical technique used (mastectomy vs. quadrantectomy) did not significantly influence modesty perceptions. Patients provided valuable suggestions to improve privacy and modesty during RT. This study demonstrates that modesty is an important issue for women undergoing RT, which can be influenced by personal characteristics and hospital-related factors. A reflection about the need to address modesty concerns and to incorporate dedicated interventions for protecting patients' physical and emotional well-being is warranted. Initiatives to improve communication, involvement, and body image support should also be integrated into the care path of patients to better their overall therapeutic experience. This study paves the way for broader research and interventions in daily cancer care.

Ultra-Hypofractionated Whole Breast Radiotherapy with Automated Hybrid-VMAT Technique: A Pilot Study on Safety, Skin Toxicity and Aesthetic Outcomes.

The most prevalent treatment-related side effect related to adjuvant radiotherapy (RT) for breast cancer is acute skin toxicity in the irradiated area. The purpose of this single-institution pilot study is to provide preliminary clinical results on the feasibility and safety of a breast ultra-hypofractionated radiation treatment delivered using an automated hybrid-VMAT technique. Skin damage was assessed both with clinical examination and objectively using a Cutometer equipment. Patients received 26 Gy to the whole breast and 30 Gy to the tumoral bed in 5 fractions using an automated hybrid-VMAT approach with the option for the breath hold technique if necessary. Acute and late toxicities were clinically evaluated at baseline, 1- and 6-months after treatment using the CTC-AE v.5.0 scale. An instrumental evaluation of the skin elasticity was performed using a Cutometer® Dual MP580. Two parameters per patient, R0 (the total skin firmness) and Q1 (the elastic recovery), were registered at the different timelines. From June 2022 to January 2024, 30 patients, stage T1-T2, N0 were enrolled in the study. Four out of 30 (13.3%) patients reported G2 acute skin toxicities. At 6 months, G2 late toxicity was registered in 3 patients (10%). A total of 2160 measures of R0 and Q1 were recorded. At 1 month after treatment, no correlation was found between measured values of R0 and Q1 and clinical evaluation. At 6 months after treatment, clinical late toxicity ≥1 was strongly associated with decreased R0 and Q1 values ≥24% (p = 0.003) and ≥18% (p = 0.022), respectively. Ultra-hypofractionated whole-breast radiotherapy, when supported by advanced treatment techniques, is both feasible and safe. No severe adverse effects were observed at any of the different timeframes. Acute and late skin toxicities were shown to be lower in contrast to data presented in the literature.

How Effective is Deep Inspiration Breath Hold in Minimizing Cardiac Doses During Hybrid Radiotherapy Treatment for Left-Sided Breast Cancer with Comprehensive Regional Nodes?

In the context of left breast cancer radiotherapy, long term cardiopulmonary toxicity has been well-documented, significant efforts have been undertaken to mitigate such toxicity by using 4D gating, deep inspiration breath-hold(DIBH) and active breath control(ABC) techniques. To evaluate and compare the cardio-pulmonary radiation doses incurred during postmastectomy radiotherapy (PMRT) in two distinct breathing conditions such as DIBH and Free Breathing (FB), with a specific focus on the left chest wall with comprehensive regional nodal irradiation. A prospective dosimetric study was conducted on 15 patients who received adjuvant loco-regional radiotherapy of chest-wall (CW), supraclavicular fossa(SCF), and internal mammary region(IMC), with or without axilla. Two sets of planning CT scans were taken in DIBH and FB conditions. The dosimetric difference between DIBH CT and FB CT plans analyzed using Wilcoxon signed-rank test, employing SPSS software version 21.0. Comparison of DIBH and FB parameters for target coverage revealed a statistically significant advantage with DIBH in SCF(D95, V90, p<0.017) and IMC(D98, V90 & V95, p<0.03). Dosimetric characteristics of heart and LAD exhibited statistically significant lower doses with DIBH (V20, V25, and Dmean, p<0.001) compared to FB plans. Lung doses were similar with no discernible advantage of one technique over the other. Other OARs such as contralateral breast (p=0.027) and esophagus (p=0.001) received lower doses with the DIBH technique while the spinal cord (p=0.691) and thyroid(p=0.496) showed no significant difference. Maximum heart distance (p= 0.001), central lung distance (p= 0.011) and Haller index (p= 0.001) exhibited statistical significance between the two techniques, whereas chest wall separation showed no significant statistical difference (p=0.629). DIBH demonstrates a substantial reduction in cardiac and LAD doses compared to the FB technique. This study underscores the efficacy of DIBH as a viable strategy for mitigating cardiac and LAD radiation doses in left-sided breast cancer patients undergoing PMRT of chest wall with comprehensive regional nodes.

2879: Continuous Positive Airway Pressure in Radiotherapy in Breast Cancer: A Prospective Trial

2879: Continuous Positive Airway Pressure in Radiotherapy in Breast Cancer: A Prospective Trial

799: Real world data of cardiotoxicity following breast cancer irradiation in low risk Asian population

799: Real world data of cardiotoxicity following breast cancer irradiation in low risk Asian population

3216: Can we predict response after stereotactic body radiotherapy in oligometastatic breast cancer?

3216: Can we predict response after stereotactic body radiotherapy in oligometastatic breast cancer?

Single preoperative radiation therapy with delayed surgery for low-risk breast cancer: Oncologic outcome, toxicity and cosmesis of the SPORT-DS phase I trial

BackgroundA novel approach using single-fraction preoperative partial breast irradiation (PBI) for low-risk breast cancer is under study. We sought to investigate the rate of pathologic response (pR), toxicities and cosmetic results related to this new treatment strategy. MethodsWomen of 65 years or older with stage I unifocal luminal A breast cancer were eligible for inclusion in this phase I prospective trial. Patients received a single 20 Gy dose of PBI followed by breast-conserving surgery (BCS) 3 months later. The primary endpoint was the pR rate, and the secondary endpoints were radiation therapy-related toxicity and cosmetic results. ResultsThirteen patients were treated, with a median age of 71. Eleven patients (84.6 %) had pR with a median residual cellularity of 1 % (range: 0–10 %). At median follow-up of 48.5 months, no recurrences or cancer-related deaths were recorded. Acute radiation therapy-related toxicity were limited to grade 1 dermatitis and breast pain. At the 1-year follow-up, there were one grade 2 fat necrosis and two grade 3 toxicities (wound infection and hematoma). Only grade 1 toxicities remained at 2 years, but one grade 2 toxicity (fibrosis/induration) developed by the 3-year follow-up. Three-year patient-reported cosmetic outcomes were good or excellent in 60 % of patients. ConclusionsSingle-fraction preoperative PBI preceding BCS for low-risk breast cancer is feasible, relatively well tolerated and leads to a high level of pR. The 3-month interval after PBI seems to place surgery in a post-radiation inflammatory phase. Further delay between PBI and surgery could improve pR and cosmetic outcome. NCT03917498.

817: Surface-guided setup and intrafraction motion in free-breathing breast cancer radiation therapy

817: Surface-guided setup and intrafraction motion in free-breathing breast cancer radiation therapy

1343: Exploring the safety and efficacy of proton radiotherapy for breast cancer in pregnant women

1343: Exploring the safety and efficacy of proton radiotherapy for breast cancer in pregnant women

2522: Optimal pressure of CPAP for reduction mean heart dose in left-sided breast cancer radiotherapy

2522: Optimal pressure of CPAP for reduction mean heart dose in left-sided breast cancer radiotherapy

3443: Omission of breast cancer radiotherapy in selected patients

3443: Omission of breast cancer radiotherapy in selected patients

2856: Could surface imaging in breast cancer radiotherapy detect early lymphoedema?: The Calibrate Study.

2856: Could surface imaging in breast cancer radiotherapy detect early lymphoedema?: The Calibrate Study.

Intraoperative radiation therapy for early-stage breast cancer.

Intraoperative radiotherapy (IORT) offers more convenience compared to external beam radiotherapy (EBRT) following breast-conserving surgery for early-stage breast cancer. This study describes the implementation of IORT at a metropolitan academic cancer center. Demographics, tumor characteristics, margin status, adjunct EBRT, and cosmetic results were retrospectively analyzed in patients undergoing BCS with IORT. IORT consists of 20 gray delivered to the partial mastectomy cavity. From 2015 to 2020, 171 patients (65.5% African American) were included. Histologically, 104 (60.8%) patients had invasive ductal carcinoma (IDC), while 67 (39%) patients had DCIS only. Seventeen (15.9%) patients with IDC and 12 (8.6%) patients with DCIS had positive margins. There were 15 ipsilateral breast recurrences (8.8%) and three patients (20%) developed systemic disease. Twenty-five patients (14.6%) underwent adjuvant EBRT. The local recurrence-free survival at 60 months from date of IORT was 89.4% (95% CI 82.7%-93.6%). For overall survival (OS), 168 (98.2%) patients were alive at a median follow-up of 51.4 months, and three total deaths were recorded. IORT is a highly desirable and convenient alternative to EBRT for early-stage breast cancer especially for patients with poor compliance. IORT has an acceptable ipsilateral recurrence while not precluding adjunct EBRT based upon the final pathologic report.

CT-based radiomics for predicting breast cancer radiotherapy side effects

Skin inflammation with the potential sequel of moist epitheliolysis and edema constitute the most frequent breast radiotherapy (RT) acute side effects. The aim of this study was to compare the predictive value of tissue-derived radiomics features to the total breast volume (TBV) for the moist cells epitheliolysis as a surrogate for skin inflammation, and edema. Radiomics features were extracted from computed tomography (CT) scans of 252 breast cancer patients from two volumes of interest: TBV and glandular tissue (GT). Machine learning classifiers were trained on radiomics and clinical features, which were evaluated for both side effects. The best radiomics model was a least absolute shrinkage and selection operator (LASSO) classifier, using TBV features, predicting moist cells epitheliolysis, achieving an area under the receiver operating characteristic (AUROC) of 0.74. This was comparable to TBV breast volume (AUROC of 0.75). Combined models of radiomics and clinical features did not improve performance. Exclusion of volume-correlated features slightly reduced the predictive performance (AUROC 0.71). We could demonstrate the general propensity of planning CT-based radiomics models to predict breast RT-dependent side effects. Mammary tissue was more predictive than glandular tissue. The radiomics features performance was influenced by their high correlation to TBV volume.

Identification of variables and development of a prediction model for DIBH eligibility in left-sided breast cancer radiotherapy: a prospective cohort study with temporal validation

ObjectiveTo identify variables associated with a patients’ ability to reproducibly hold their breath for deep-inspiration breath-hold (DIBH) radiotherapy (RT) and to develop a predictive model for DIBH eligibility.MethodsThis prospective, single-institution, IRB-approved observational study included women with left-sided breast cancer treated between January 2023 and March 2024. Patients underwent multiple breath-hold sessions over 2–3 consecutive days. DIBH waveform metrics and clinical factors were recorded and analysed. Logistic mixed modelling was used to predict DIBH eligibility, and a temporal validation cohort was used to assess model performance.ResultsIn total, 253 patients were included, with 206 in the model development cohort and 47 in the temporal validation cohort. The final logistic mixed model identified increasing average breath-hold duration (OR, 95% CI: 0.308, 0.104–0.910. p = 0.033) and lower amplitude (OR, 95% CI: 0.737, 0.641–0.848. p < 0.001) as significant predictors of DIBH eligibility. Increasing age was associated with higher odds of being ineligible for DIBH (OR, 95% CI: 1.040, 1.001–1.081. p = 0.044). The model demonstrated good discriminative performance in the validation cohort with an AUC of 80.9% (95% CI: 73.0-88.8).ConclusionThe identification of variables associated with DIBH eligibility and development of a predictive model has the potential to serve as a decision-support tool. Further external validation is required before its integration into routine clinical practice.

Postoperative Radiotherapy Using VMAT for RNI Including IMN in Breast Cancer: Report of Short-term Follow-up.

The application of volumetric-modulated arc therapy (VMAT) in postoperative radiotherapy for breast cancer has recently garnered considerable interest, especially when regional lymph node irradiation (RNI), is extended to include the internal mammary node (IMN) region, along with whole-breast or chest wall irradiation. This study aimed to assess both acute and late toxicities, as well as breast cancer outcomes, during the observation period. This retrospective study aimed to assess the safety and feasibility of VMAT in postoperative radiotherapy, including the IMN region, for patients with breast cancer at our hospital. We included 33 eligible patients who received postoperative VMAT radiotherapy, including the IMN region, between November 2018 and July 2021. The primary indications for implementing VMAT were the presence of IMN metastases before primary systemic therapy or more than four axillary lymph node metastases. The median prescribed dose for the chest wall or conserved breast and regional lymph nodes was 50 Gy in 25 fractions. In 16 cases, a simultaneous boost (median, 10 Gy) was administered to residual lymph node metastases. VMAT facilitated a reduction in the mid- or high-dose range to organs at risk, exemplified by V20Gy and V40Gy of the ipsilateral lung, which were 24.10% and 6.84%, respectively, while ensuring adequate target dose irradiation, V45Gy=95.23%. No serious adverse events, including symptomatic radiation pneumonitis, occurred during the 15-month median observation period. Our findings demonstrate the safety and effectiveness of postoperative radiotherapy for breast cancer, including the IMN region, when using VMAT.

PTCOG international survey of practice patterns and trends in utilization of proton therapy for breast cancer

Purpose/objectivesThe indications, techniques, and extent to which proton beam therapy (PBT) is employed for breast cancer are unknown. We seek to determine PBT utilization for breast cancer. Materials/methodsThe Particle Therapy Co-Operative Group (PTCOG) Breast Subcommittee developed an IRB-approved 29-question survey and sent it to breast cancer radiation oncologists at all active PBT centers worldwide in June 2023. Descriptive statistics were used to summarize responses, and comparisons by continent were performed using Fisher’s exact tests. ResultsOf 79 surveys distributed, 28 recipients submitted responses (35 % response rate) representing fifteen U.S., 8 European, and 5 Asian centers (continent response rate 50 %, 38 %, and 18 %, respectively). Overall, 93 % reported treating breast cancer patients with PBT; 13 (50 %) have treated ≥100 breast cancer patients at their center since opening. Most (89 %) have pencil beam scanning technology. Nearly half (46 %) use moderate hypofractionation (15–20 fractions) for regional nodal irradiation and 42 % conventional fractionation (25–30 fractions). More European centers prefer hypofractionation (88 %) vs. Asian (50 %) and U.S. (21 %) centers (p = 0.003). Common patient selection methods were practitioner determination/patient preference (n = 16) and comparative plan evaluation (n = 15). U.S. centers reported the most experience with breast PBT, with 71 % having treated ≥100 breast cancer patients vs. 38 % in Europe and none in Asia (p = 0.001). Of respondent centers, 39 % enrolled ≥75 % of breast PBT patients on a research study. ConclusionUtilization, patient selection methods, and dose-fractionation approaches for breast cancer PBT vary worldwide. These survey data serve as a benchmark from which successor surveys can provide insight on practice pattern evolution.

Cancer therapy-related cardiac dysfunction after radiation therapy for breast cancer: results from the BACCARAT cohort study

BackgroundRadiation therapy (RT) for breast cancer (BC) can result in subtle cardiac dysfunction that can occur early after treatment. In 2022, the European Society of Cardiology (ESC) published the first guidelines in cardio-oncology with a harmonized definition of cancer therapy-related cardiac dysfunction (CTRCD). The aim of this study was to evaluate CTRCD occurrence over 24 months of follow-up after RT in BC patients and to analyze the association with cardiac radiation exposure.MethodsThe prospective monocentric BACCARAT study included BC patients treated with RT without chemotherapy, aged 40–75 years, with conventional and 2D Speckle tracking echocardiography performed before RT, 6 and 24 months after RT. Based on ESC cardio-oncology guidelines, CTRCD and corresponding severity were defined with left ventricle ejection fraction and global longitudinal strain decrease, occurring at 6 or 24 months after RT. Dosimetry for whole heart, left ventricle (LV) and left coronary artery (left anterior descending and circumflex arteries (CX)) was considered to evaluate the association with CTRCD, based on logistic regressions (Odds Ratio – OR and 95% confidence interval – 95%CI). Youden index based on receiver operating characteristic curve analysis was used to identify the optimal threshold of dose-volume parameters for predicting CTRCD.ResultsThe study included 72 BC patients with a mean age of 58 ± 8.2 years. A total of 32 (44%) patients developed CTRCD during follow-up: 20 (28%) mild CTRCD, 7 (9%) moderate CTRCD, and 5 (7%) severe CTRCD. Cardiac radiation doses were generally higher among patients with CTRCD rather than non-CTRCD. Dose-response relationships were significant for mean CX dose (OR = 2.48, 95%CI (1.12–5.51), p = 0.02) and marginally significant for V2 of LV (OR = 1.03 95%CI (1.00-1.06), p = 0.05). V2 of LV ≥ 36% and mean CX dose ≥ 1.40 Gy thresholds were determined to be optimal for predicting CTRCD.ConclusionFor BC patients treated with RT without chemotherapy, CTRCD can be observed in an important proportion of the population over 24 months after treatment. Left ventricle and circumflex coronary artery exposure were found to be associated with CTRCD and could be used for the prediction of such cardiotoxicity. Further research remains needed to confirm these results.Trial RegistrationClinicalTrials.gov Identifier- NCT02605512.